Skip to main content
PMC home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1999 May;83(5):582–587. doi: 10.1136/bjo.83.5.582

Natural history of amblyopia untreated owing to lack of compliance

K Simons 1, M Preslan 1
PMCID: PMC1723047  PMID: 10216059

Abstract

AIMS—A prospective study of the efficacy of amblyopia treatment in preschool children has recently been called for, requiring an untreated control group. The present study assessed data from patients with amblyopia untreated owing to lack of compliance, or with amblyopia risk factors, to determine outcome.
METHODS—Longitudinal data were obtained from 18 4-6 year old patients who had initially been screened for amblyopia, strabismus, and/or bilateral refractive error, failed to comply with prescribed treatment, and in whom amblyopia was detected at a rescreening approximately a year later. The data from three previous studies comparing outcome of patients compliant and non-compliant with amblyopia treatment were also reanalysed.
RESULTS—One child of the 18, who wore glasses sporadically, showed some improvement in visual acuity in the amblyopic eye. Otherwise, no child showed an improvement, and seven of the 17 (41%) for whom visual acuities were available at both screenings showed a deterioration of visual acuity in the amblyopic eye, including three who apparently developed amblyopia for the first time. A child with an ametropic risk factor for amblyopia whose visual acuity was not obtained at the first screening and who was largely non-compliant presented with amblyopia at the second screening. The reanalysed data from the three previous studies demonstrated a significantly poorer visual acuity outcome in the amblyopic eye in the non-compliant patient groups than in the compliant groups in each study.
CONCLUSION—Preschool children with amblyopia or its risk factors are at risk of having the current amblyopia deteriorate, or of developing amblyopia, if not treated. These results raise questions about the ethical acceptability of a prospective study of amblyopia treatment at these ages.



Full Text

The Full Text of this article is available as a PDF (113.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Assaf A. A. The sensitive period: transfer of fixation after occlusion for strabismic amblyopia. Br J Ophthalmol. 1982 Jan;66(1):64–70. doi: 10.1136/bjo.66.1.64. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Atkinson J., Braddick O., Robier B., Anker S., Ehrlich D., King J., Watson P., Moore A. Two infant vision screening programmes: prediction and prevention of strabismus and amblyopia from photo- and videorefractive screening. Eye (Lond) 1996;10(Pt 2):189–198. doi: 10.1038/eye.1996.46. [DOI] [PubMed] [Google Scholar]
  3. Aurell E., Norrsell K. A longitudinal study of children with a family history of strabismus: factors determining the incidence of strabismus. Br J Ophthalmol. 1990 Oct;74(10):589–594. doi: 10.1136/bjo.74.10.589. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Aurell E., Norrsell K. A longitudinal study of children with a family history of strabismus: factors determining the incidence of strabismus. Br J Ophthalmol. 1990 Oct;74(10):589–594. doi: 10.1136/bjo.74.10.589. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Awaya S., Miyake S. Form vision deprivation amblyopia: further observations. Graefes Arch Clin Exp Ophthalmol. 1988;226(2):132–136. doi: 10.1007/BF02173300. [DOI] [PubMed] [Google Scholar]
  6. Bray L. C., Clarke M. P., Jarvis S. N., Francis P. M., Colver A. Preschool vision screening: a prospective comparative evaluation. Eye (Lond) 1996;10(Pt 6):714–718. doi: 10.1038/eye.1996.166. [DOI] [PubMed] [Google Scholar]
  7. Calcutt C., Murray A. D. Untreated essential infantile esotropia: factors affecting the development of amblyopia. Eye (Lond) 1998;12(Pt 2):167–172. doi: 10.1038/eye.1998.42. [DOI] [PubMed] [Google Scholar]
  8. Daw N. W. Critical periods and amblyopia. Arch Ophthalmol. 1998 Apr;116(4):502–505. doi: 10.1001/archopht.116.4.502. [DOI] [PubMed] [Google Scholar]
  9. Epelbaum M., Milleret C., Buisseret P., Dufier J. L. The sensitive period for strabismic amblyopia in humans. Ophthalmology. 1993 Mar;100(3):323–327. doi: 10.1016/s0161-6420(13)32170-8. [DOI] [PubMed] [Google Scholar]
  10. Fulton A. B., Mayer D. L. Esotropic children with amblyopia: effects of patching on acuity. Graefes Arch Clin Exp Ophthalmol. 1988;226(4):309–312. doi: 10.1007/BF02172956. [DOI] [PubMed] [Google Scholar]
  11. Good W. V., da Sa L. C., Lyons C. J., Hoyt C. S. Monocular visual outcome in untreated early onset esotropia. Br J Ophthalmol. 1993 Aug;77(8):492–494. doi: 10.1136/bjo.77.8.492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hiscox F., Strong N., Thompson J. R., Minshull C., Woodruff G. Occlusion for amblyopia: a comprehensive survey of outcome. Eye (Lond) 1992;6(Pt 3):300–304. doi: 10.1038/eye.1992.59. [DOI] [PubMed] [Google Scholar]
  13. Hudak D. T., Magoon E. H. Poverty predicts amblyopia treatment failure. J AAPOS. 1997 Dec;1(4):214–215. doi: 10.1016/s1091-8531(97)90040-9. [DOI] [PubMed] [Google Scholar]
  14. Hård A. L., Williams P., Sjöstrand J. Do we have optimal screening limits in Sweden for vision testing at the age of 4 years? Acta Ophthalmol Scand. 1995 Dec;73(6):483–485. doi: 10.1111/j.1600-0420.1995.tb00320.x. [DOI] [PubMed] [Google Scholar]
  15. Ingram R. M., Arnold P. E., Dally S., Lucas J. Emmetropisation, squint, and reduced visual acuity after treatment. Br J Ophthalmol. 1991 Jul;75(7):414–416. doi: 10.1136/bjo.75.7.414. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Ingram R. M., Arnold P. E., Dally S., Lucas J. Results of a randomised trial of treating abnormal hypermetropia from the age of 6 months. Br J Ophthalmol. 1990 Mar;74(3):158–159. doi: 10.1136/bjo.74.3.158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Ingram R. M., Traynar M. J., Walker C., Wilson J. M. Screening for refractive errors at age 1 year: a pilot study. Br J Ophthalmol. 1979 Apr;63(4):243–250. doi: 10.1136/bjo.63.4.243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Ingram R. M., Traynar M. J., Walker C., Wilson J. M. Screening for refractive errors at age 1 year: a pilot study. Br J Ophthalmol. 1979 Apr;63(4):243–250. doi: 10.1136/bjo.63.4.243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Ingram R. M., Walker C. Refraction as a means of predicting squint or amblyopia in preschool siblings of children known to have these defects. Br J Ophthalmol. 1979 Apr;63(4):238–242. doi: 10.1136/bjo.63.4.238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Ingram R. M., Walker C. Refraction as a means of predicting squint or amblyopia in preschool siblings of children known to have these defects. Br J Ophthalmol. 1979 Apr;63(4):238–242. doi: 10.1136/bjo.63.4.238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Keech R. V., Kutschke P. J. Upper age limit for the development of amblyopia. J Pediatr Ophthalmol Strabismus. 1995 Mar-Apr;32(2):89–93. doi: 10.3928/0191-3913-19950301-07. [DOI] [PubMed] [Google Scholar]
  22. Köhler L., Stigmar G. Vision screening of four-year-old children. Acta Paediatr Scand. 1973 Jan;62(1):17–27. doi: 10.1111/j.1651-2227.1973.tb08060.x. [DOI] [PubMed] [Google Scholar]
  23. Lee J., Adams G., Sloper J., McIntyre A. Future of preschool vision screening. Cost effectiveness of screening for amblyopia is a public health issue. BMJ. 1998 Mar 21;316(7135):937–938. [PubMed] [Google Scholar]
  24. Lennerstrand G., Jakobsson P., Kvarnström G. Screening for ocular dysfunction in children: approaching a common program. Acta Ophthalmol Scand Suppl. 1995;(214):26–40. doi: 10.1111/j.1600-0420.1995.tb00585.x. [DOI] [PubMed] [Google Scholar]
  25. Levartovsky S., Oliver M., Gottesman N., Shimshoni M. Factors affecting long term results of successfully treated amblyopia: initial visual acuity and type of amblyopia. Br J Ophthalmol. 1995 Mar;79(3):225–228. doi: 10.1136/bjo.79.3.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Lithander J., Sjöstrand J. Anisometropic and strabismic amblyopia in the age group 2 years and above: a prospective study of the results of treatment. Br J Ophthalmol. 1991 Feb;75(2):111–116. doi: 10.1136/bjo.75.2.111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Moseley M. J. Preschool vision screening: a recent report calls for a halt. Br J Ophthalmol. 1998 Jul;82(7):722–723. doi: 10.1136/bjo.82.7.722. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Preslan M. W., Novak A. Baltimore Vision Screening Project. Phase 2. Ophthalmology. 1998 Jan;105(1):150–153. doi: 10.1016/s0161-6420(98)91813-9. [DOI] [PubMed] [Google Scholar]
  29. Preslan M. W., Novak A. Baltimore Vision Screening Project. Ophthalmology. 1996 Jan;103(1):105–109. doi: 10.1016/s0161-6420(96)30753-7. [DOI] [PubMed] [Google Scholar]
  30. Rahi J. S., Dezateux C. The future of preschool vision screening services in Britain. BMJ. 1997 Nov 15;315(7118):1247–1248. doi: 10.1136/bmj.315.7118.1247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Rutstein R. P., Eskridge J. B. Stereopsis in small-angle strabismus. Am J Optom Physiol Opt. 1984 Aug;61(8):491–498. doi: 10.1097/00006324-198408000-00001. [DOI] [PubMed] [Google Scholar]
  32. Simons K., Elhatton K. Artifacts in fusion and stereopsis testing based on red/green dichoptic image separation. J Pediatr Ophthalmol Strabismus. 1994 Sep-Oct;31(5):290–297. doi: 10.3928/0191-3913-19940901-05. [DOI] [PubMed] [Google Scholar]
  33. Simons K. Preschool vision screening: rationale, methodology and outcome. Surv Ophthalmol. 1996 Jul-Aug;41(1):3–30. doi: 10.1016/s0039-6257(97)81990-x. [DOI] [PubMed] [Google Scholar]
  34. Sjöstrand J., Abrahamsson M. Risk factors in amblyopia. Eye (Lond) 1990;4(Pt 6):787–793. doi: 10.1038/eye.1990.124. [DOI] [PubMed] [Google Scholar]
  35. Stewart-Brown S. L., Snowdon S. K. Evidence-based dilemmas in pre-school vision screening. Arch Dis Child. 1998 May;78(5):406–407. doi: 10.1136/adc.78.5.406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Williams C., Harrad R. A., Sparrow J. M., Harvey I., Golding J. Future of preschool vision screening. Conclusions for or against services are invalid without appropriate research evidence. BMJ. 1998 Mar 21;316(7135):937–937. doi: 10.1136/bmj.316.7135.937a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Williamson T. H., Andrews R., Dutton G. N., Murray G., Graham N. Assessment of an inner city visual screening programme for preschool children. Br J Ophthalmol. 1995 Dec;79(12):1068–1073. doi: 10.1136/bjo.79.12.1068. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Woodruff G., Hiscox F., Thompson J. R., Smith L. K. Factors affecting the outcome of children treated for amblyopia. Eye (Lond) 1994;8(Pt 6):627–631. doi: 10.1038/eye.1994.157. [DOI] [PubMed] [Google Scholar]
  39. Woodruff G., Hiscox F., Thompson J. R., Smith L. K. Factors affecting the outcome of children treated for amblyopia. Eye (Lond) 1994;8(Pt 6):627–631. doi: 10.1038/eye.1994.157. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES